Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 10 01 1640 1640 Lou Marion Solomon Department of Anesthesiology, Philippine General Hospital, University of the Philippines, Metro Manila, Philippines. Alexandra Nina Odi Department of Anesthesiology, Philippine General Hospital, College of Medicine, University of the Philippines, Metro Manila, Philippines. 2026 05 18 2026 07 11 Robot-Assisted Kidney Transplantation (RAKT) is a minimally invasive alternative to open surgery, offering several benefits but posing anesthetic challenges related to pneumoperitoneum and patient positioning. These factors can compromise cardiorespiratory function and electrolyte balance. This case report discusses the anesthetic management of the first RAKT at the Philippine General Hospital, emphasizing the detection and treatment of intraoperative hypercapnia—an infrequent yet potentially serious complication that may result in acidosis, hyperkalemia, and arrhythmia. https://aacc.tums.ac.ir/index.php/aacc/article/view/1640